oroceods S 12 Account number ktptlOnC6 15 14 Gross proceeds paid fo en attorney State Copy or Extra, File Copy 16 State tax s1thhold $ 17 State/Macs state no. 18 State Income Fc,,,,1009-rorsc JEVINE5 Depanmont of the Tmancy • InteMN Rtnanue Service EFTA00176005 Response to Request No. 6 to